Abstract
Toxocariasis is a cosmopolitan helminthiasis linked to contamination with Toxocara cati or Toxocara canis. Only six isolated cases of pleural toxocariasis have been reported in the literature. We describe a case of pleurisy with isolated eosinophilia varying between 600 and 1500/mm3 likely linked o presumptive toxocariasis in a 72-year-old patient. Our patient was admitted to hospital with severe dyspnoea, asthenia and diarrhoea. Imaging studies confirmed right unilateral pleurisy without any parenchymal involvement. Serology of serum and pleural fluid was positive for anti-Toxocara antibodies by ELISA and immunoblotting. Treatment by pleural drainage and anti-parasitic medication with albendazole for 8 days resulted in the resolution of symptoms. A decrease in the levels of polynuclear eosinophils and total IgE confirmed the clinical resolution. The presence of hypereosinophilia in pleural fluid should evoke a diagnosis of pleural toxocariasis. Clinical symptoms and imaging are non-specific, but positive serology for anti-Toxocara antibodies in serum and pleural fluid can confirm the diagnosis.
This is a preview of subscription content, log in via an institution to check access.
Data availability
Not applicable.
Code availability
Not applicable.
References
Vallentin B, Carsin A, Dubus JC (2015) Toxocariasis: an unusual cause of pleural effusion. Pediatr Pulmonol 50(10):E35-36
Haute autorité de santé. Actualisation des actes de biologie médicale relatifs au diagnostic sérologique de la toxocarose (Larva migrans viscérale). Disponible sur: https://www.has-sante.fr/upload/docs/application/pdf/2017-03/argumentaire_toxocarose_vd.pdf
Blanco-Pérez JJ, Abal-Arca J, Rocha-García F (2006) Pleural effusion and toxocariasis. Med Clin (Barc) 126(2):75
Ranasuriya G, Mian A, Boujaoude Z, Tsigrelis C (2014) Pulmonary toxocariasis: a case report and literature review. Infection Juin 42(3):575–578
Camus P (n.d.) Pneumotox » Pattern » V.b - Eosinophilic pleural effusion. Pneumotox On Line. [Internet]. Disponible sur: https://www.pneumotox.com/pattern/view/32/V.b/eosinophilic-pleural-effusion
Natali D, Tulliez M, Burgel PR, Mouthon L, Dusser D, Montani D (2008) Eosinophilic pleural effusion associated to Churg and Strauss syndrome. Rev Pneumol Clin 64(5):229–233
Krenke R, Nasilowski J, Korczynski P, Gorska K, Przybylowski T, Chazan R et al (2009) Incidence and aetiology of eosinophilic pleural effusion. Eur Respir J 34(5):1111–1117
Bachmeyer C, Lamarque G, Morariu R, Molina T, Bourée P, Delmer A (2003) Visceral larva migrans mimicking lymphoma. Chest 123(4):1296–7
Park SJ, Jang CW, Kim YK, Seo YH, Kim KH, Kwon TG et al (2021) Toxocariasis-associated acute perimyocarditis with cardiogenic shock: a case report. Am J Case Rep 22:e930573
Bruart J, Remacle P, Henneghien C, Jonckheer J (1987) Pleural effusion and Toxocara canis. Rev Mal Respir 4(1):35–37
Seki M, Hiromatsu K, Kosai K, Fukuda Y, Kakugawa T, Nakamura F et al (2006) A case of toxocariasis with eosinophilic pleural effusion. Kansenshogaku Zasshi 80(6):716–720
Ashwath ML, Robinson DR, Katner HP (2004) A presumptive case of toxocariasis associated with eosinophilic pleural effusion: case report and literature review. Am J Trop Med Hyg déc 71(6):764
Jeanfaivre T, Cimon B, Tolstuchow N, de Gentile L, Chabasse D, Tuchais E (1996) Pleural effusion and toxocariasis. Thorax janv 51(1):106–107
Fitzsimmons CM, Falcone FH, Dunne DW (2014) Helminth Allergens, Parasite-specific IgE, and its protective role in human immunity. Front Immunol 5:61
Hogarth-Scott RS, Johansson SG, Bennich H (1969) Antibodies to Toxocara in the sera of visceral larva migrans patients: the significance of raised levels of IgE. Clin Exp Immunol déc 5(6):619–625
Gould HJ, Sutton BJ, Beavil AJ, Beavil RL, McCloskey N, Coker HA et al (2003) The biology of IGE and the basis of allergic disease. Annu Rev Immunol 21:579–628
Dattoli VCC, Freire SM, Mendonça LR, Santos PC, Meyer R, Alcantara-Neves NM (2011) Toxocara canis infection is associated with eosinophilia and total IgE in blood donors from a large Brazilian centre. Trop Med Int Health TM IH 16(4):514–7
Chen J, Zhou DH, Nisbet AJ, Xu MJ, Huang SY, Li MW et al (2012) Advances in molecular identification, taxonomy, genetic variation and diagnosis of Toxocara spp. Infect Genet Evol J Mol Epidemiol Evol Genet Infect Dis 12(7):1344–1348
Ishiwata K, Shinohara A, Yagi K, Horii Y, Tsuchiya K, Nawa Y (2004) Identification of tissue-embedded ascarid larvae by ribosomal DNA sequencing. Parasitol Res 92(1):50–52
Wu Z, Nagano I, Xu D, Takahashi Y (1997) Primers for polymerase chain reaction to detect genomic DNA of Toxocara canis and T. cati. J Helminthol 71(1):77–8
Acknowledgements
The authors thank Jean-Michel Dewitte for his excellent technical assistance with the Toxocara immunoblots and Val Hopwood for editing assistance.
Author information
Authors and Affiliations
Contributions
MH and JL: wrote the article; ASD, MC, SL and BS: reviewed the article; ST and BB contributed to the clinical management of the patient.
Corresponding author
Ethics declarations
Ethics approval
Not applicable.
Consent to participate
Not applicable.
Consent for publication
The patient gave their informed consent for the use of the data.
Competing interests
The authors declare no competing interests.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Hirabidian, M., Thierry, S., Deleplancque, AS. et al. A rare case of presumptive pleural toxocariasis. Eur J Clin Microbiol Infect Dis 42, 781–786 (2023). https://doi.org/10.1007/s10096-023-04595-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-023-04595-9